Annex “B” Republic of the Philippines ' , COMMISSION ON ELECTIONS Affix Latest | Photo Here CERTIFICATE OF CANDIDACY FOR _ PUNONG BARANGAY [NSTRUCTIONS: Read wat before ng wis Torn) File this in THREE (3) LEGIBLE copies with the COMELEC Office concermed, during regular office hours (8:00 AM to 5:00 PM ONLY), on any day from September 23, 2017 to September 30, 2017. Tites sich as Dr., Atty., Don, Ginoo, Sefior, Datu, Sultan, Bai, Sefiora, Kapitan or other similar titles are expressly prohibited. This certificate shall be sworn before a notary public or any official authorized to administer oath, The Election Officer may ‘administer the oath on the COCs filed within thelr area of jurisdiction, free of charge. 4. No filing fee shall be imposed. Thereby announce my candidacy for the position of PUNONG BARANGAY of BARANGAY. Gity/ Municipality of Province of in the October 23, 2017 Barangay and Sangguniang Kabataan (SK) Elections; and after having been sworn to in accordance with law, I hereby state the following: 1. NAME: a a. SEX: 15. AGE: fae 1) C]uwie Creme . 16, DATE OF BIRTH : 17, PLACE OF BIRTH: 3. RESIDENCE/ADDRESS : ccty/Mun 3.2 CtyiMunicipalty Province pera 18. CIVIL STATU 3.4 House No Steet / Subsvison rer Single widowjer Married at oe of Sos mares ‘4, ADDRESS FOR ELECTION PURPOSES : (Could be the same as No.3) 19, PROFESSION OR OCCUPATION : ‘5. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCTOBER 23, 2017: 51 Inthe Phitpines: COLT torres CopT Ne erhonns 20. 1AM AREGISTERED VOTER OF: rr 52 Inthe above sated Barangay: | mcctveus EO) ta athens mete 1AM A FILIPINO CITIZEN. [EXECUTED A SWORN RENUNCIATION OF FOREIGN CITIZENSHIP. (I APPLICABLE, ATTACH A COPY) {IAM NOT A PERMANENT RESIDENT OF, OR AY IMMIGRANT TO, A FOREIGN COUNTRY. IAM ELIGILE FOR THE OFFICE {SEEK TO BE ELECTED TO. 40, 1 AMNOT A MEMBER OF ANY POLITICAL PARTY, GROUP OR COALITION OF POLITICAL PARTIES. 4H WILLFILE, WITH THE OFFICES OF THE COMMISSION, WITHIN THIRTY (30) DAYS AFTER ELECTION DAY, MY FULL {TRUE AND HTEMIZED STATEMENT OF CONTRIBUTIONS AND EXPENDITURES (SOCE) IN CONNECTION WITH THE. uecrioN 42, WILL SUPPORT AND DEFEND THE CONSTTTUTION OF THE REPUBLIC OF THE PHILIPPINES AND WILL MAINTAIN {TRUE FAITH #ND ALLEGIANCE THERETO. I WILL OBEY THE LAW'S, LEGAL ORDERS AND DECREES PROMULGATED BY “Tie DULY CONSTITUTED AUTHORITIES 1 IMPOSE THIS OBLIGATION UPON MYSELF VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE OF EVASION. 13,1 GIVE CONSENT TO THE PROCESSING OF THE INFORMATION STATED HEREIN BY THE COMMISSION ON ELECTIONS FOR ELECTION AND OTHER PURPOSES AS MAY BE PROVIDED BY LAM, SUCH AS BP BLG. 881 AND R.A. HO. 10173 [AISO KNOWN AS THE DATA PRIVACY ACT OF 2012, AMONG OTHERS. rey certly thatthe facts tated herein are true and correct to the best of my knowledge, —Sionature of Candidate over Printed Name 4 ‘oar SUBSCRIBED AND SWORN to before me this __ day of 2017, at , affiant exhibiting to me an Identification document/card which contains a photograph and signature bearing No. ‘esued by eon] Doc, No. Page No.5, (4th 91509 ccumerey an) a Book No, (Officer Authorized to Administer Oath) Series of 2017. "ns Fe CaN POOPED OR REPRODUCED ANDI AVALABLE AT THE COMELE FICS FREE OF MAGE 09/01/2017, ‘ORNAY Be DOwcoNDED FROM Te COLE OPEL MEETS au o) ht